Epilepsy is a relatively common condition among young people. However, large strides have been made in controlling epileptic seizures using medication. This has meant that the majority of epileptics lead virtually independent lives with little risk of convulsions.
Pregnancy presents a unique challenge in the life of a woman with epilepsy. This is not only because of anxiety about what effect pregnancy might have on the condition (which is unpredictable), but also because of such factors as the effect of the pregnancy on the dose of medication.
There is also the fear of convulsions and its potential consequences on the pregnancy, the effect of the anticonvulsant medication on the fetus and many more.
All these questions and many others have been tackled in this chapter. Not all the answers are known and it will be pretentious for any physician to suggest otherwise. However, as in most chronic conditions that individuals learn to live with, the optimal results, both in terms of a problem-free pregnancy and a good outcome, lie in the meticulous control of the condition.
The buck, as the old adage goes, ultimately stops with the individual. The decision to take medication as recommended always lies with the patient.
As we shall see while answering specific questions, there is no such thing as a "safe" anticonvulsant.
The potential for adverse effect on the baby does, however, differ from one group of anticonvulsants to another. Such consequences are uncommon, even in collective terms. Moreover, options for changing from one anticonvulsant to another that may be deemed relatively safer are sometimes quite limited in real life. This is because there may be justifiable anxiety about abandoning a drug with proven effectiveness for another, which may not be as good in that particular individual. Moreover, a switch needs to be made before conception, to be effective in skirting the potential adverse effects on the fetus.
Many pregnancies among women with epilepsy are "discovered" at a five to six week stage, too late for any such measure. All these subjects are dealt with in detail in this chapter.
Effects of epilepsy on pregnancy and the fetus
As an epileptic on medication, how should I expect pregnancy to affect my condition?
It is impossible for anybody to predict. Roughly 50 per cent of patients see no change in the seizure frequency. Of the remainder, some will experience more seizures and some fewer.
Can the fact that I have epilepsy cause complication to the pregnancy?
The aim of managing epilepsy in pregnancy will be to prevent seizures, as these could lead to injury to you and may cause a late miscarriage or premature delivery, with consequent loss of your baby.
Apart from that, there is known to be a slight increase in the risk of bleeding in pregnancy. Bleeding, when it occurs, is usually light and painless. It very rarely threatens the well-being of the pregnancy.
Epilepsy does not make you more prone to develop other pregnancy-related problems, such as pre-eclampsia.
What about the baby?
Yes, there is an increased risk (compared to the general population) of major malformations, especially those of the skull, mouth or heart. Most of these can be detected by ultrasound scanning, optimally at around eighteen to twenty weeks of gestation. Nine out of ten (90%) babies born to epileptic mothers are free of any malformations.